Men and Hair Loss

Hair loss afflicts millions of people—and not just men, though their hair loss is often the most noticeable. Most women, too, experience some degree of hair loss as they grow older.

Hair is not living tissue like skin but is composed of a protein called keratin, which is also the building block of fingernails and toenails. Each hair grows from a root enclosed by a follicle, a small pocket in the skin, which is nourished by blood vessels. Hair grows according to a genetic program (hormones also are involved), about half an inch a month; each hair grows for two to six years.

Part of your hair is growing and part is resting at any given moment. After the rest period, the hair falls out. It’s normal to lose 50 to 100 hairs a day (not many out of the 100,000 in the average youthful head). When a hair falls out, a new one presumably grows in, but the catch comes when it doesn’t— when more falls out than grows back in. Genetic baldness is caused by the body’s failure to produce new hairs. Nearly two thirds of men develop some form of balding.

By far the most common form of hair loss is androgenetic alopecia, usually called male-pattern baldness. (Alopecia is the medical term for hair loss.) It is typified by the receding hairline that eventually turns into a bald pate (sometimes with very fine, thin hairs replacing the original growth). By age 50, half of all men of European origin will experience this kind of hair loss, which can begin as early as age 20. Several other genetic groups—some Asians, some Africans and African Americans and Native Americans—seldom or never get bald in this manner. Though the exact process that shuts down the hair follicles has yet to be explained, the male hormone testosterone plays a role.

What causes it? Hereditary pattern baldness is determined by our genes and hormones. Sudden, dramatic hair loss, however, can have many causes. In both men and women, severe emotional stress, fad diets if pursued to the point of malnutrition, thyroid disorders, anemia and various drugs and medications (particularly therapy for cancer) can cause hair loss. Large doses of vitamin A also may cause the problem.

Hair loss caused by constantly wearing tight-fitting wigs or hats is called friction alopecia. Traction alopecia is hair loss caused by pulling hair too tight in ponytails or braids, so that it falls out. In most of these cases, hair begins to grow again once the underlying problem is corrected or corrects itself.

More serious is alopecia areata (“area baldness”), which causes loss of hair in patches and is thought to be an autoimmune disorder. It can proceed to complete hair loss and affects about five million people in the United States, male and female. This condition can sometimes be treated successfully, and anyone who suffers from it should see a dermatologist. In many cases, it simply goes away by itself and new hair grows back in.

It’s impossible to prevent male-pattern baldness, and in most people the baldness will almost always become more noticeable with age. For hair loss caused by illness, medication, radiation therapy or hormonal fluctuations, hair will usually grow back when the condition has improved or treatment has ended.

Hair loss home remedies

You can find hundreds of hair-loss remedies offered on the Internet and in drug and health-food stores. But if your hair loss is male-pattern baldness, there aren’t any nonmedical approaches that will halt hair loss or restore your hair. At the same time, there are hair-care practices and cosmetic remedies that can help you protect the hair you have and make the most of your appearance.

Choose a shampoo that’s gentle on your hair and scalp. Use baby shampoo, and shampoo no more than once a day. “Revitalizing” shampoos or multiproduct shampoo “systems” that promise to restore hair will not grow back your hair.

Dry your hair with care and avoid excessive toweling. If you use a hair dryer, keep it on a low setting.

Comb tenderly. Always handle your hair gently, particularly if it is thinning. Combing is less injurious to hair than brushing.

Don’t overbrush. If you must brush, do so when your hair is dry. Be sure to disentangle the hair from the brush. Avoid hairbrushes and combs that pull your hair. Use either a natural-bristle brush or a nylon brush with rounded edges.

Resort to camouflage. A short haircut and styling aids such as gels and mousses can hide thinning. Hair dyes can minimize the visual and psychological effects of hair loss. Permanent dyes can dry out the hair shaft if used over long periods but won’t injure the root or promote additional hair loss. Whether using dye at home or in a salon, don’t skip the patch test for possible allergic reactions. At home, follow package directions carefully.

Be skeptical of products that promise hair growth. Products containing lanolin, vitamins or wheat germ are harmless when applied to the head, but they won’t make hair grow or prevent it from falling out. And there is no evidence to support any herbal products for hair growth. Products with large amounts of estrogen might stimulate hair growth (though the evidence for this is poor); unfortunately, there are almost always unpleasant side effects.

Treating hair loss with drugs and devices

Two medications and a laser device may offer some help for baldness, though they are far from perfect. Both require lifetime commitment to sustain hair growth. Any new hair may vanish if you discontinue treatment.

Minoxidil. Originally developed as a blood pressure drug, minoxidil (brand name Rogaine) stimulated hair growth as a side effect—and was then shown to produce new hair growth when applied to the skin. It is available in two formulations, 2 percent (for men and women) and 5 percent (for men only). There is disagreement about whether the 5 percent is more effective.

Minoxidil affects only the crown of the head; a receding hairline is rarely restored. New hair is usually thinner and lighter, like baby hair. And many men will not experience any significant hair growth.

Finasteride. What a difference the dose makes. At a 5-milligram dosage, finasteride (brand name Proscar) reduces urinary symptoms in men with enlarged prostates; at a 1-milligram dosage, the same prescription drug (called Propecia) counters male-pattern baldness. If you have an enlarged prostate, your doctor may reasonably prescribe finasteride. But if you are facing hair loss—a cosmetic issue, though distressing for many men—do the drug’s benefits outweigh its drawbacks?

Taken orally, Propecia inhibits an enzyme that converts testosterone to dihydrotestosterone (DHT), a hormone that can cause hair follicles to shrink. The drug’s benefits are well documented, and side effects, including erectile dysfunction and loss of libido, are relatively uncommon. (Finasteride is not approved for women with hair loss, since it causes severe birth defects in male fetuses; pregnant or potentially pregnant women should not even touch the tablets.)

Clinical trials show that Propecia increases conversion of hairs into the active growth phase, reverses shrinking of hair follicles and slows progression of hair loss. It works best for men who are beginning to lose hair, not those who are completely bald, and is better for hair loss on the crown than for receding hairlines. It may take at least six months to see results. Most hair growth occurs by two years, but the drug must be taken indefinitely to maintain the benefits. If your balding is due to something other than androgenetic alopecia (male-pattern hair loss), the drug won’t work at all.

Though there’s no evidence of serious problems, we still hesitate to recommend Propecia. Younger men, the prime candidates, would need to take a drug that affects their hormones for the rest of their lives to maintain results—and there simply are no data yet to back its safety over that many years.

Other things to keep in mind:

Propecia lowers readings of the prostate-specific antigen (PSA) screening test for prostate cancer—by 40 to 50 percent in one study. If you’re already taking it (or are considering doing so) and are having a PSA test, tell your doctor so the results can be adjusted.

It’s not clear whether Propecia affects the risk of prostate cancer. An analysis of the Prostate Cancer Prevention trial found that the drug reduced the overall risk of being diagnosed with prostate cancer, but slightly increased the risk of diagnosis with the most serious form of the disease. However, a 2013 follow-up study in the New England Journal of Medicine was reassuring— it found that finasteride did not increase mortality rates from prostate cancer.

Propecia is not thought to affect sperm production, but some research suggests it might negatively affect fertility in men with conditions like obesity (which on its own can impair fertility). If you and your partner are having trouble conceiving, try stopping Propecia to see if it makes a difference.